The Neer Impingement Test is a standardized maneuver used by healthcare professionals to screen for the cause of shoulder pain. It is one of the most common physical examination techniques performed during an assessment of the shoulder complex. The test involves a specific, passive movement of the arm designed to replicate symptoms, allowing the clinician to narrow down potential diagnoses and guide treatment planning.
The Purpose of the Neer Impingement Test
The primary goal of the Neer test is to identify signs of mechanical compression, specifically Subacromial Impingement Syndrome (SIS). This condition occurs when soft tissues within the subacromial space become pinched beneath the acromion (the bony projection of the shoulder blade). The tissues most commonly irritated include the supraspinatus tendon, the long head of the biceps tendon, and the subacromial bursa.
The maneuver intentionally narrows the space between the humerus and the anterior acromion. The test is designed to forcefully compress these structures against the coracoacromial arch. Reproduction of pain during this movement suggests that these structures are being irritated or compressed against the bone.
How the Neer Impingement Test is Performed
The test is carried out with the patient seated or standing, with the affected arm relaxed at their side. The examiner uses one hand to stabilize the shoulder blade, or scapula, to prevent it from rotating upward during the maneuver. This stabilization ensures that the movement primarily stresses the structures beneath the acromion.
The examiner then positions the patient’s arm into internal rotation, which is accomplished by turning the arm so that the thumb points downward. Internal rotation is crucial because it forces the greater tuberosity of the humerus forward, maximizing compression within the subacromial space.
With the arm internally rotated, the examiner uses their opposite hand to passively move the arm forward into full elevation, or forward flexion. The movement is passive, meaning the patient does not use their own muscles to lift the arm. The examiner continues to raise the arm until it reaches its maximal range of elevation or until the patient reports pain.
Interpreting a Positive Result
A positive Neer Impingement Test is indicated by the reproduction of the patient’s familiar shoulder pain during the passive forward flexion maneuver. The discomfort is typically reported in the anterior or lateral aspect of the shoulder. Pain often occurs as the arm approaches maximum elevation, usually between 90 and 180 degrees of flexion. This suggests that structures within the subacromial space are being pinched.
The test is highly sensitive for screening subacromial impingement, meaning a negative result makes the condition less likely. However, a positive result only indicates mechanical irritation and is not specific enough to identify which tissue is damaged. The pain could originate from the supraspinatus tendon, the biceps tendon, or an inflamed bursa.
If the pain is eliminated after a local anesthetic injection into the subacromial space, it strongly confirms impingement as the source of the discomfort. Because various shoulder conditions can yield a positive result, the Neer test is rarely used in isolation to finalize a diagnosis.
Other Diagnostic Tests for Shoulder Impingement
Since the Neer test has limitations in specificity, it is routinely paired with other maneuvers to create a more accurate diagnostic picture. The Hawkins-Kennedy Test is another common maneuver that stresses the subacromial space. It involves forcing the shoulder into internal rotation while held at 90 degrees of forward flexion. Reproduction of pain during this maneuver further supports the presence of impingement.
The Empty Can Test (Jobe test) is often used to assess the integrity and strength of the supraspinatus muscle. This test involves holding the arm out to the side with the thumb pointing downward while the examiner applies downward resistance.
The Painful Arc Test involves the patient actively raising their arm out to the side. The examiner looks for pain that occurs specifically between 60 and 120 degrees of elevation. Using a cluster of three or more positive tests significantly improves the overall accuracy of diagnosing subacromial impingement syndrome.